Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.
Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.
HPB (Oxford). 2022 Oct;24(10):1720-1728. doi: 10.1016/j.hpb.2022.05.002. Epub 2022 May 13.
To determine whether the short-term benefits associated with an enhanced recovery after surgery programme (ERAS) following pancreaticoduodenectomy (PD) vary with age.
830 consecutive patients who underwent PD between January 2009 and March 2019 were divided according to age: elderly (≥75 years) vs. non-elderly patients (<75 years). Within each age group, cohort characteristics and outcomes were compared between patients treated pre- and post-ERAS (ERAS was systematically introduced in December 2012). Univariable and multivariable analysis were then performed, to assess whether ERAS was independently associated with length of hospital stay (LOS).
Of the entire cohort, 577 of 830 patients (69.5%) were managed according to an ERAS protocol, and 170 patients (20.5%) were aged ≥75 years old. Patients treated post-ERAS were significantly more comorbid than those pre-ERAS, with a mean Charlson Comorbidity Index of 4.6 vs. 4.1 (p < 0.001) and 6.0 vs. 5.7 (p = 0.039) for the non-elderly and elderly subgroups, respectively. There were significantly fewer medical complications in non-elderly patients treated post-ERAS compared to pre-ERAS (12.4% vs. 22.4%; p = 0.002), but not in elderly patients (23.6% vs. 14.0%; p = 0.203). On multivariable analysis, ERAS was independently associated with reduced LOS in both elderly (14.8% reduction, 95% CI: 0.7-27.0%, p = 0.041) and non-elderly patients (15.6% reduction, 95% CI: 9.2-21.6%, p < 0.001), with the effect size being similar in each group.
ERAS protocols can be safely applied to patients undergoing pancreaticoduodenectomy irrespective of age. Implementation of an ERAS protocol was associated with a significant reduction in postoperative LOS in both elderly and non-elderly patients, despite higher comorbidity in the post-ERAS period.
确定胰十二指肠切除术（PD）后加速康复外科（ERAS）方案相关的短期益处是否因年龄而异。
2009 年 1 月至 2019 年 3 月期间连续 830 例接受 PD 的患者根据年龄分为老年（≥75 岁）与非老年患者（<75 岁）。在每个年龄组内，比较 ERAS 治疗前后患者的队列特征和结局（ERAS 于 2012 年 12 月系统引入）。然后进行单变量和多变量分析，以评估 ERAS 是否与住院时间（LOS）独立相关。
在整个队列中，830 例患者中有 577 例（69.5%）根据 ERAS 方案进行治疗，170 例（20.5%）年龄≥75 岁。与 ERAS 治疗前相比，接受 ERAS 治疗后的患者合并症更多，非老年患者的平均 Charlson 合并症指数分别为 4.6 和 4.1（p<0.001），老年患者分别为 6.0 和 5.7（p=0.039）。与 ERAS 治疗前相比，非老年患者 ERAS 治疗后医疗并发症明显减少（12.4% vs. 22.4%；p=0.002），但老年患者则不然（23.6% vs. 14.0%；p=0.203）。多变量分析显示，ERAS 与老年患者 LOS 降低独立相关（降低 14.8%，95%CI：0.7-27.0%，p=0.041）和非老年患者 LOS 降低独立相关（降低 15.6%，95%CI：9.2-21.6%，p<0.001），两组的效果大小相似。
无论年龄大小，胰十二指肠切除术患者均可安全应用 ERAS 方案。尽管 ERAS 治疗后患者的合并症更高，但实施 ERAS 方案与老年和非老年患者术后 LOS 显著降低相关。
